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Barbara Baker John Perry

A Study of Expanding Prescriptive Authority for Controlled Substances to Advanced Registered Nurse Practitioners 2004 HB 595. Barbara Baker John Perry. Purpose of the Study. Discuss the potential positive and negative effects of authorizing ARNPs to prescribe controlled substances in Kentucky

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Barbara Baker John Perry

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  1. A Study of Expanding Prescriptive Authority for Controlled Substances to Advanced Registered Nurse Practitioners 2004 HB 595 Barbara Baker John Perry

  2. Purpose of the Study • Discuss the potential positive and negative effects of authorizing ARNPs to prescribe controlled substances in Kentucky • Review research literature • Describe ARNP education relevant to prescribing controlled substances in Kentucky • Review and compare pharmacology curriculum for physicians and ARNPs at UK and UofL • Gather opinions of interested and affected parties • Surveys and interviews • Evaluate relationship between the quantity of controlled substances and ARNPs authority • Data from U.S. DEA and Verispan 2 of 10

  3. Schedule Examples I Heroin II OxyContin III Tylenol with codeine IV Valium V Cough syrups Categories of Prescription Drugs Nonscheduled Drugs Examples Antibiotics Penicillin Antihistamines Allegra Cholesterol Lipitor 3 of 10

  4. Findings • Little research has been performed specifically examining the effects of ARNPs prescribing controlled substances • Physician and ARNP pharmacology courses at UK and UofL include similar content and time related to controlled substances • Physicians may have more time in clinical practice • Most states allow ARNPs to write controlled substance prescriptions 4 of 10

  5. All states and DC currently authorize ARNPs to prescribe all medicines except for controlled substances 44 states and DC grant expanded authority for controlled substances 36 states allow prescribing of Schedules II through V 8 states grant full authority 28 states grant authority with various limitations Kentucky is among the six states that do not allow ARNPs to prescribe controlled substances No authorization in 6 states: AL, FL, HI, MO, KY, and GA Findings: Status of ARNP Controlled Substance Prescribing 5 of 10

  6. Proponents Improve access to health care Increase autonomy Increase accountability Opponents Portal for drug diversion Question educational qualifications Patient safety concerns Comments of Interested Parties 6 of 10

  7. Findings: Practitioner Surveys • ARNPs largely support being granted authority while physicians are generally opposed ResponseARNP Physician Yes, no limitations 60% 4% Yes, with limitations 36% 27% No 3% 68% No Opinion 1% 1% 7 of 10

  8. Findings: Practitioner Surveys • Some agreement between physicians and ARNPs on limitations to authority if limitations are enacted LimitationARNP Physician Collaborative agreement include specific classes of substances 64% 97% Submit collaborative agreement to Board of Nursing 70% 90% Collaborating physician must review ARNP regularly 61% 99% 8 of 10

  9. Findings: Data Analysis Effect on Number of Prescriptions Schedule II 1.4% increase per year Schedule III 6.4% total increase Schedule IV no effect • There is evidence that states where ARNPs can prescribe controlled substances have larger per capita quantities than states where they cannot Effect on Quantity in Grams Schedule II 6.6% increase per year 9 of 10

  10. A Study of Expanding Prescriptive Authority for Controlled Substances to Advanced Registered Nurse Practitioners 2004 HB 595

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